Update on Interim Zika Virus Clinical Guidance and Recommendations - Clinician Outreach and Communication Activity (COCA) Call February 25, 2016 ...
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Update on Interim Zika Virus Clinical Guidance
and Recommendations
Clinician Outreach and Communication Activity
(COCA) Call
February 25, 2016
Office of Public Health Preparedness and Response
Division of Emergency Operations
1
TODAY’S PRESENTER
Emily Petersen, MD
Medical Officer
Division of Reproductive Health
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
TODAY’S PRESENTER
Katherine Fleming-Dutra, MD
Medical Epidemiologist
Division of Healthcare Quality Promotion
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention
TODAY’S PRESENTER
Alexa Oster, MD
Medical Epidemiologist
Division of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
Centers for Disease Control and Prevention Zika Virus Update on Interim Zika Virus Clinical Guidance and Recommendations Katherine Fleming-Dutra, MD Medical Officer Alexa Oster, MD Medical Officer Emily Petersen, MD Medical Officer February 25, 2016
What is Zika virus disease (Zika)?
Disease spread primarily through the bite of an
Aedes mosquito infected with Zika virus
– Aggressive daytime biters, prefer to bite
people, live indoors and outdoors
– Can also bite at night
Symptoms are mild and last for several days to a Aedes aegypti mosquito
week
Transmission of Zika virus
Other modes of transmission
– Intrauterine and perinatal transmission
– Sexual transmission
– Laboratory exposure
Reported mode
– Blood transfusion
The Subcommittee on Arbovirus Laboratory Safety of the American Committee on Arthropod-Borne Viruses. Laboratory safety for arboviruses and certain other
viruses of vertebrates. Am J Trop Med Hyg 1980;29:1359–81.
European Centre for Disease Prevention and Control. Rapid risk assessment: Zika virus epidemic in the Americas: potential association with microcephaly and
Guillain-Barre syndrome. Stockholm, Sweden: European Centre for Disease Prevention and Control; 2015.
Symptoms Most common symptoms of Zika are – Fever – Rash – Joint pain – Conjunctivitis (red eyes) Other symptoms include – Muscle pain – Headache
Areas with Zika Virus:
Countries & Territories in the Americas
as of February 23, 2016 http://wwwnc.cdc.gov/travel/notices/Zika Virus in the United States Local vector-borne transmission of Zika virus has not been reported in the continental United States With current outbreak in the Americas, cases among U.S. travelers will likely increase Imported cases may result in virus introduction and local transmission in some areas of U.S.
Zika Virus in Pregnancy
Limited information is available
Existing data show:
– No evidence of increased susceptibility
– Infection can occur in any trimester
– Incidence of Zika virus infection in pregnant women is
not known
– No evidence of more severe disease compared with
non-pregnant people
Centers for Disease Control and Prevention, CDC Health Advisory: Recognizing, Managing, and Reporting Zika Virus Infections in Travelers Returning from Central America, South America, the
Caribbean and Mexico, 2016.
Besnard, M., et al., Evidence of Perinatal Transmission of Zika Virus, French Polynesia, December 2013 and February 2014. Euro Surveill, 2014. 19(14): p. 1-5.
Oliveira Melo, A., et al., Zika Virus Intrauterine Infection Causes Fetal Brain Abnormality and Microcephaly: Tip of the Iceberg? Ultrasound in Obstetrics & Gynecology, 2016. 47(1): p. 6-7.Zika Virus and Microcephaly
Brazil: >5200 cases of suspected microcephaly temporally linked with
current Zika outbreak
French Polynesia: 17 cases of neurologic malformations among fetuses
and newborns that were temporally linked to 2013–2014 outbreak
Investigations in Brazil and French Polynesia are ongoing
Victora CG, Schuler-Faccini L, Matijasevich A, Ribeiro E, Pessoa A, Barros FC. Microcephaly in Brazil: how to interpret reported numbers? Lancet 2016 Feb
13;387(10019):621-4.
European Centre for Disease Prevention and Control. Zika virus epidemic in the Americas: potential association with microcephaly and Guillain-Barre syndrome.
21 January 2016. Stockholm: ECDC; 2016.
Besnard M, Mallet H. Increase of cerebral congenital malformations among newborns and fetus in French Polynesia 2014-2015. 15 November 2015. Polynesie
Francaise.Microcephaly and Zika
What we know What we don’t know
• Small number of positive test results • Causal relation between Zika virus and
for Zika virus infection in infants with microcephaly or other adverse
microcephaly pregnancy outcomes
• Microcephaly pattern consistent with • Full spectrum of phenotypes in affected
Fetal Brain Disruption Sequence infants
• Based on photos/scans of a small • Impact of timing of infection during
number of affected infants from Brazil pregnancy
• Retrospective investigation in French • Impact of severity of maternal infection
Polynesia outbreak in 2013-2014 • Magnitude of the possible risk of
• Infants with other intrauterine microcephaly and other adverse
infections such as cytomegalovirus pregnancy outcomesPregnancy Outcomes and Zika Virus
Pregnant woman residing in Brazil
– Symptoms of Zika virus disease at 18 weeks
Ultrasound findings
– 16 weeks: Normal
– 21 weeks: Fetal microcephaly with moderate ventriculomegaly and partial agenesis of
the cerebellar vermis
– 27 weeks: Fetal microcephaly with ventricular dilation, asymmetry of hemispheres,
hypoplastic cerebellum and absence of cerebellar vermis
– 40 weeks: Fetal microcephaly with calcifications
Testing
– 28 weeks: Amniotic fluid positive for Zika virus RNA, serum and urine negative by Zika
RT-PCR
Delivery at 40 weeks
– Infant born with head circumferencePregnancy Outcomes and Zika Virus
Pregnant woman residing in Brazil
– Symptoms of Zika virus disease at 10 weeks
Ultrasound findings
– 22 weeks: Fetal mild hypoplasia of cerebellar vermis and head circumferencePregnancy Outcomes and Zika Virus
Pregnant woman residing in Brazil from preconception until 29 weeks of gestation
– Symptoms of Zika virus disease at 13 weeks
Ultrasound findings
– 14 & 20 weeks: normal fetal growth & anatomy
– 29 weeks: evidence of fetal anomalies
– 32 weeks: intrauterine growth restriction, microcephaly, and other brain abnormalities
Termination at 32 weeks
– Brain weight 4 SD below normal
– Zika virus RNA detected in fetal brain tissue
– Almost complete agyria and internal hydrocephalus of lateral ventricles
Mlakar J, Korva M, Tul N, et al. Zika Virus Associated with Microcephaly. NEJM 2016 Feb 10.Pregnancy Outcomes and Zika Virus
Two pregnant women in Brazil had clinical signs of Zika virus disease
during first trimester
Infants born with microcephaly at 36 and 38 weeks gestation
– Died within 20 hours of birth
Zika virus RNA detected in brain tissue of both infants
Significant histopathologic changes in the brain
– Parenchymal calcification and necrosis
Martines RB, Bhatnagar J, Keating MK, et al. Notes from the Field: Evidence of Zika Virus Infection in Brain and Placental Tissues from Two Congenitally Infected
Newborns and Two Fetal Losses — Brazil, 2015. MMWR Morb Mortal Wkly Rep 2016;65(Early Release):1–2.Pregnancy Outcomes and Zika Virus
Two additional women in Brazil had clinical signs of Zika virus disease
during the first trimester
– Two fetal losses at 11 & 13 weeks gestation
Zika virus RNA detected in products of conception
Zika viral antigen detected by immunohistochemistry in one case
Histopathologic changes in one case
• Calcification and fibrosis in the chorionic villi
Martines RB, Bhatnagar J, Keating MK, et al. Notes from the Field: Evidence of Zika Virus Infection in Brain and Placental Tissues from Two Congenitally Infected
Newborns and Two Fetal Losses — Brazil, 2015. MMWR Morb Mortal Wkly Rep 2016;65(Early Release):1–2.Centers for Disease Control and Prevention Update: Interim Guidance for Health Care Providers Caring for Pregnant Women and Women of Reproductive Age with Possible Zika Virus Exposure — United States, 2016 Speaker: Emily Petersen, MD
CDC Recommendations: Pregnant Women Considering Travel Pregnant women in any trimester should consider postponing travel to areas where Zika virus transmission is ongoing Pregnant women who are considering travel to one of these areas should talk to their healthcare provider and strictly follow steps to prevent mosquito bites during the trip
Zika Virus Disease Prevention:
Pregnant Women
CDC recommends taking the following measures to prevent mosquito
bites:
– Use EPA-registered insect repellent
• EPA-registered repellents, including DEET and permethrin, are
safe and effective for pregnant women
– Wear long-sleeved shirts and pants to cover exposed skin
– Wear permethrin-treated clothes
– Stay and sleep in screened-in or air-conditioned rooms
– Practice mosquito prevention strategies indoors and outdoors
throughout the entire dayEvaluating Pregnant Travelers
Recommendations
– Ask pregnant women about travel history.
– If history of travel to an area with ongoing Zika virus transmission during
pregnancy, evaluate for symptoms of and test for Zika virus infection.
– Pregnant women with male partners who have Zika virus infection or
potential Zika virus exposure should use condoms or abstain from sexual
activity for the duration of pregnancy.Centers for Disease Control and Prevention
CDC Recommendations:
Pregnant Women and Women of Reproductive Age
With Possible Zika Virus Exposure
Updated CDC guidance includes:
– Serologic testing can be offered to asymptomatic pregnant women with
travel history to areas with ongoing Zika virus transmission
– Screening, testing, and management of pregnant women
– Counseling of women of reproductive age (15–44 years)Testing
CDC Recommendations:
Diagnostic testing
Reverse Transcription-Polymerase Chain Reaction (RT-PCR) for viral RNA in
serum collected ≤7 days after illness onset
Serology for Immunoglobulin M (IgM) in serum collected ≥4 days after
illness onset
• Cross-reactivity can occur among related flaviviruses
• Plaque Reduction Neutralization Test (PRNT) can be performed to
measure virus-specific neutralizing antibodiesCDC Recommendations: Testing for Asymptomatic Pregnant Women with Possible Zika Virus Exposure Serologic (IgM) testing can be offered to asymptomatic pregnant women Negative IgM result could suggest a recent infection did not occur and obviate need for serial ultrasounds Information about performance of testing of asymptomatic persons limited
Testing Algorithm for Pregnant Women with History of Travel to Areas with Ongoing Zika Virus Transmission
Interim Guidelines: Pregnant Women With History Of Travel To Areas With Ongoing Zika Virus Transmission
Interim Guidelines:
Symptomatic Pregnant Women With History Of Travel
To Areas With Ongoing Zika Virus Transmission
Test pregnant women with two or
more of the following symptoms
within 2 weeks of travel:
• Acute onset of fever
• Maculopapular rash
• Arthralgia
• Conjunctivitis
RT-PCR test should be performed
during the first week of clinical
illness.
IgM may also be indicated
depending on timing.
Testing should be coordinated
through state, local, or territorial
health department.Interim Guidelines:
Asymptomatic Pregnant Women With History Of
Travel To Areas With Ongoing Zika Virus Transmission
Serologic (IgM) testing can be
offered.
Testing should be coordinated
through state, local, or
territorial health department.Interim Guidelines:
Pregnant Women With History Of Travel To Areas
With Ongoing Zika Virus Transmission Positive test
• Zika virus RT-PCR
• Zika virus IgM positive with
confirmatory neutralizing
antibody titers that are ≥4-
fold higher than dengue
virus neutralizing antibody
titers in serum
Inconclusive test
Zika virus IgM positive with
neutralizing antibody titers that
areInterim Guidelines: Pregnant Women With History Of Travel To Areas With Ongoing Zika Virus Transmission
Interim Guidelines:
Pregnant Women With History Of Travel To Areas
With Ongoing Zika Virus Transmission 30
Serologic (IgM)
testing should be
performed.
RT-PCR on amniotic
fluid.Interim Guidelines: Pregnant Women With History Of Travel To Areas With Ongoing Zika Virus Transmission 31
Testing Algorithm for Pregnant Women Residing in Areas with Ongoing Zika Virus Transmission
Areas With Ongoing Zika Virus Transmission:
Evaluating Pregnant Residents
Healthcare providers should
– Evaluate for symptoms of Zika virus infection
– Perform appropriate testing according to algorithm
Recommendations
– Offer serologic testing at
• Initiation of prenatal care
• Follow up mid-2nd trimester
– Routine ultrasound screening recommended for all pregnant women at 18–20
weeks of gestation
– Pregnant women with male partners who have or are at risk of Zika virus infection
should use condoms or abstain from sexual activity for the duration of pregnancyInterim Guidelines: Pregnant Women Residing in Areas with Ongoing Zika Virus Transmission
Symptomatic Pregnant Women Residing in Areas with Ongoing Zika Virus Transmission
Interim Guidelines:
Symptomatic Pregnant Women Residing in Areas With Ongoing Zika
Virus Transmission
Test pregnant women with two or
more of the following symptoms:
• Acute onset of fever
• Maculopapular rash
• Arthralgia
• Conjunctivitis
RT-PCR test should be performed
during the first week of clinical
illness.
IgM may also be indicated depending
on timing.
Testing should be coordinated
through state, local, or territorial
health department.Interim Guidelines:
Symptomatic Pregnant Women Residing in Areas With Ongoing Zika
Virus Transmission
Positive test
• Zika virus RT-PCR
• Zika virus IgM positive with
confirmatory neutralizing
antibody titers that are ≥4-
fold higher than dengue
virus neutralizing antibody
titers in serum.
Inconclusive test
Zika virus IgM positive with
neutralizing antibody titers that
areInterim Guidelines: Symptomatic Pregnant Women Residing in Areas With Ongoing Zika Virus Transmission
Interim Guidelines:
Symptomatic Pregnant Women Residing in Areas With Ongoing Zika
Virus Transmission
Serologic (IgM)
testing should be
performed.
RT-PCR on amniotic
fluid.Interim Guidelines:
Symptomatic Pregnant Women Residing in Areas With Ongoing Zika
Virus Transmission
Serologic (IgM)
testing should be
performed.Asymptomatic Pregnant Women Residing in Areas with Ongoing Zika Virus Transmission
Interim Guidelines:
Asymptomatic Pregnant Women Residing in Areas With Ongoing Zika
Virus Transmission
Serologic (IgM)
testing can be
performed.
Local health officials
should determine
when to implement
testing of
asymptomatic
pregnant women
based on information
about levels of Zika
virus transmission
and laboratory
capacity.Interim Guidelines:
Asymptomatic Pregnant Women Residing in Areas With Ongoing Zika
Virus Transmission
Positive test
Zika virus IgM positive with
confirmatory neutralizing
antibody titers that are ≥4-fold
higher than dengue virus
neutralizing antibody titers in
serum.
Inconclusive test
Zika virus IgM positive with
confirmatory neutralizing
antibody titers that areInterim Guidelines:
Asymptomatic Pregnant Women Residing in Areas With Ongoing Zika
Virus Transmission
Serologic (IgM)
testing should be
performed.Interim Guidelines:
Asymptomatic Pregnant Women Residing in Areas With Ongoing Zika
Virus Transmission
RT-PCR on
amniotic fluid.Interim Guidelines:
Asymptomatic Pregnant Women Residing in Areas With Ongoing Zika
Virus Transmission
Serologic (IgM)
testing should be
performed.
RT-PCR on
amniotic fluid.Zika Virus Infection and Pregnancy: Clinical Management
Zika Virus Infection and Pregnancy: Clinical Management
Positive or inconclusive Zika virus testing results
– Antepartum
• Consider serial ultrasounds every 3–4 weeks
• Referral to maternal-fetal medicine specialist is recommended
– Postpartum
• Histopathologic examination of the placenta and umbilical cord
• Testing of frozen placental tissue and cord tissue for Zika virus RNA
• Testing of cord serum for Zika and dengue virus IgM and neutralizing
antibodiesWomen of Reproductive Age Residing in Areas with Ongoing Zika Virus Transmission
Special Considerations:
Women of Reproductive Age Residing in Areas of
Ongoing Zika Virus Transmission
Providers should counsel women regarding
– Mosquito bite prevention
– Reproductive life plan and preconception care
• Reproductive health history, values, and preferences
– Zika virus
• Signs and symptoms of Zika virus disease and when to seek care
• Potential risks of Zika virus infection during pregnancySpecial Considerations:
Women of Reproductive Age Residing in Areas of
Ongoing Zika Virus Transmission
For women who do not desire pregnancy, provide counseling on
– Correct and consistent use of effective contraception
– Condoms to reduce risk of contracting sexually transmitted infectionsSpecial Considerations:
Women of Reproductive Age Residing in Areas of
Ongoing Zika Virus Transmission
For women who desire pregnancy
– Emphasize mosquito prevention
– Provide preconception counseling
– Review risks of Zika virus disease transmission during pregnancy
• Refer to updates at http://www.cdc.gov/zika/
– If prior Zika virus infection
• Inform patients there is no evidence Zika virus poses risk of birth
defects for future pregnanciesCenters for Disease Control and Prevention Update: Interim Guidelines for Healthcare Providers Caring for Infants and Children with Possible Zika Virus Infection — United States, February 2016 Speaker: Katherine Fleming-Dutra, MD
Acute Zika Virus Disease in Infants and Children
Perinatal Transmission of Zika Virus
Evidence of perinatal infection (near time of delivery)
– Zika virus outbreak in French Polynesia 2013–2014
• Two pregnant women with signs and symptoms consistent with Zika virus
infection around the time of delivery
• Zika virus RNA detected by RT-PCR in both mothers
• Zika virus infection was confirmed in the neonates, 1–3 days after delivery
• Unlikely that neonates were exposed to mosquitoes
• Babies recovered but long-term follow up not reported
Besnard, M., et al. Evidence of perinatal transmission of Zika virus, French Polynesia, December 2013 and February 2014. Euro Surveill, 2014. 19(14): p. 1-5.Clinical Manifestations of Zika Virus in Children
Most children asymptomatic or have mild illness
Zika virus outbreak in Yap Island, Micronesia, 2007
– Illness reported in persons 1-76 years of age
– Most common signs and symptoms: rash (macular or papular), fever,
arthralgia, conjunctivitis
– Children 0-19 years had lower attack rates than adults 20-59 years
Among 8 travel-related cases of Zika virus disease in children in US
– All had rash and at least one additional manifestation (fever,
arthralgia, and nonpurulent conjunctivitis)
Duffy MR, Chen TH, Hancock WT, Powers AM, Kool JL, Lanciotti RS, et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. The New
England journal of medicine. 2009 Jun 11;360(24):2536-43
CDC unpublished data, 2016Complications of Zika Virus
Guillain-Barré syndrome (GBS) has been reported after Zika virus infection,
but causal link has not been established
– Unclear how many children have had GBS after Zika virus infection
• Brazil: 6 patients aged 2-57 years with neurologic syndromes (GBS
and Acute Disseminated Encephalomyelitis) after Zika infection
• French Polynesia: 38 cases of GBS, none among children
– Overall, GBS incidence appears to increase with increasing age
Deaths associated with Zika are very rare
European Centre for Disease Prevention and Control. Rapid risk assessment: Zika virus infection outbreak, French Polynesia. 14 February 2014. Stockholm: ECDC; 2014.
Minstério de Saúde. Protocolo de vigilância e resposta à ocorrência de microcefalia relacionada à infecção pelo vírus Zika 2015.
http://portalsaude.saude.gov.br/images/pdf/2015/dezembro/09/Microcefalia---Protocolo-de-vigil--ncia-e-resposta---vers--o-1----09dez2015-8h.pdf
Sejvar J, Baughman A, Wise M, Morgan O. Population incidence of Guillain-Barré syndrome: a systematic review and meta-analysis. Neuroepidemiology.
2011;36(2):123-33Centers for Disease Control and Prevention
Infants whose mothers traveled to or resided in an area with ongoing Zika virus transmission during pregnancy
Infants whose mothers traveled to or resided in an area with ongoing Zika virus transmission during pregnancy
Infants whose mothers traveled to or resided in an area with ongoing Zika virus transmission during pregnancy
Infants whose mothers traveled to or resided in an area with ongoing Zika virus transmission during pregnancy
Infants whose mothers traveled to or resided in an area with ongoing Zika virus transmission during pregnancy
Infants whose mothers traveled to or resided in an area with ongoing Zika virus transmission during pregnancy
Infants whose mothers traveled to or resided in an area with ongoing Zika virus transmission during pregnancy
Infants without microcephaly or intracranial calcifications whose mothers traveled to or resided in areas with ongoing Zika transmission during pregnancy but were not tested If infant has normal head circumference, prenatal ultrasounds, postnatal ultrasounds (if performed), physical examination routine care Use clinical judgment if an infant has abnormalities other than microcephaly or intracranial calcifications – Consider testing mother before infant
Zika Virus Testing of Infants
Recommended for
– Infants with microcephaly or intracranial calcifications born to women
who traveled to or resided in an area with Zika virus transmission
while pregnant
– Infants born to mothers with positive or inconclusive test results for
Zika virus infectionEvaluation of Infants and Children (Age
Evaluation and Management of Infants and Children Aged
Evaluation and Management of Infants and Children Aged
Special Consideration Arthralgia can be difficult to detect in infants and young children and can manifest as – irritability – walking with a limp (for ambulatory children) – difficulty moving or refusing to move an extremity – pain on palpation – pain with active or passive movement of the affected joint
Recommended Testing for Acute Zika Virus Disease Test serum and, if obtained for other reasons, cerebrospinal fluid – If symptoms present for
Laboratory Evidence of Zika Virus Infection
Positive test results
– In any clinical sample
• Zika virus by culture, RNA by RT-PCR, or antigen
• Zika virus IgM with confirmatory neutralizing antibodies ≥ 4-fold
higher than dengue virus neutralizing antibodies
Inconclusive result
– Zika virus neutralizing antibodies < 4 fold higher than dengueClinical Management No specific antiviral treatment Supportive care Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) until dengue virus ruled out and in children
Guidelines for Breastfeeding for Mothers with Zika Virus Infection and Living in Areas with Zika virus Zika virus RNA has been identified in breast milk Zika virus has not been cultured from breast milk No cases of Zika transmission associated with breastfeeding have been reported Mothers are encouraged to breastfeed their infants Current evidence: benefits of breastfeeding outweigh theoretical risks
Prevention of Zika Virus in Infants and Children
Mosquito prevention
– Air conditioning or window and door screens when indoors
– Long-sleeves and long pants
– Use permethrin-treated clothing and gear
– When use as directed on the product label, most EPA*-registered
insect repellants can be used in children ≥ 2 months
– Oil of lemon eucalyptus should not be used in children < 3 years old
– Mosquito netting for carriers, strollers, or cribs for infants
*EPA= Environmental Protection Agency
Nasci, RS et al. Protection against Mosquitoes, Ticks, & Other Arthropods in Chapter 2: The Pre-Travel Consultation: Counseling & Advice for Travelers
http://wwwnc.cdc.gov/travel/yellowbook/2016/the-pre-travel-consultation/protection-against-mosquitoes-ticks-other-arthropodsPrevention of Zika Virus Infection in Infants and Children Healthcare providers should educate parents and caregivers about mosquito bite prevention in infants and children if they are traveling to or residing in areas affected by Zika virus Parents should protect infants and children with Zika virus from mosquito bites for at least one week to decrease risk of transmission to others
Centers for Disease Control and Prevention Update: Interim Guidelines for Prevention of Sexual Transmission of Zika Virus – United States, 2016 Speaker: Alexa Oster, MD
Centers for Disease Control and Prevention
Sexual Transmission of Zika Virus:
What We Know and What We Do Not Know
What we know:
Zika virus can be sexually transmitted by a man to his sex partners, and this is of particular concern
during pregnancy.
All reported cases of sexual transmission involved sex without a condom with men who had or developed
symptoms.
Sexual transmission of many infections, including those caused by other viruses, is reduced by
consistent and correct use of latex condoms.
What we do not know:
Whether infected men who never develop symptoms can transmit Zika virus to their sex partners.
How long Zika virus persists in the semen.
One report found the virus in semen at least two weeks after symptoms of infection began.
Another report found the virus in semen at least 62 days after symptoms of infection began.
Whether women with Zika infection can transmit Zika virus to their sex partners.
Whether Zika can be transmitted from oral sex.
It is known that Zika is infectious in semen.
It is unknown if Zika is infectious in other body fluids exchanged by oral sex, including saliva and vaginal fluids.Sexual Transmission of Zika Virus: CDC Recommendations for Men
Who Live in or Traveled to an Area of Active Zika Virus Transmission
Men and their pregnant sex partners:
Should abstain from sexual activity or consistently and correctly use condoms during sex (i.e., vaginal
intercourse, anal intercourse, or fellatio) for the duration of the pregnancy.
Pregnant women should discuss their male partner’s potential exposures to mosquitoes and history of
Zika-like illness with their healthcare provider; providers can consult CDC’s guidelines for evaluation and
testing of pregnant women.
Men and their nonpregnant sex partners:
If concerned about sexual transmission of Zika virus, might consider abstaining from sexual activity or
using condoms consistently and correctly during sex. Couples should take several factors into account:
Most infections are asymptomatic, and when illness does occur, it is usually mild.
Severe disease requiring hospitalization is uncommon.
Risk for acquiring vector-borne Zika virus in areas of active transmission depends on the duration and extent of
exposure to infected mosquitoes and the steps taken to prevent mosquito bites.
After infection, Zika virus might persist in semen when it is no longer detectable in blood.
At this time, testing of men for the purpose of assessing risk for sexual transmission is not recommended.
Oster AM, et al. Interim Guidelines for Prevention of Sexual Transmission of Zika Virus — United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65:120–121.Thanks to our many collaborators and partners! For more information, contact CDC 1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Selected References
Besnard M, et al. Evidence of perinatal transmission of Zika virus, French Polynesia, December 2013 and February 2014 . Euro
Surveill 2014;19(13):20751.
Duffy MR, et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med 2009;360:2536–2543.
Martines RB, Bhatnagar J, Keating MK, et al. Notes from the Field: Evidence of Zika Virus Infection in Brain and Placental Tissues from Two
Congenitally Infected Newborns and Two Fetal Losses — Brazil, 2015. MMWR Morb Mortal Wkly Rep 2016;65(Early Release):1–2..
Mlakar J, Korva M, Tul N, et al. Zika Virus Associated with Microcephaly. NEJM 2016 Feb 10.
Oliveira Melo, A., et al., Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg? Ultrasound in
Obstetrics & Gynecology, 2016. 47(1): p. 6-7.
European Centre for Disease Prevention and Control. Zika virus epidemic in the Americas: potential association with microcephaly and
Guillain-Barre syndrome. 21 January 2016. Stockholm: ECDC; 2016.
Victora et al. Microcephaly in Brazil: how to interpret reported numbers? Lancet 2016. Epub February 5, 2016.
The Subcommittee on Arbovirus Laboratory Safety of the American Committee on Arthropod-Borne Viruses. Laboratory safety for arboviruses
and certain other viruses of vertebrates. Am J Trop Med Hyg 1980;29:1359–81.
European Centre for Disease Prevention and Control. Rapid risk assessment: Zika virus epidemic in the Americas: potential association with
microcephaly and Guillain-Barre syndrome. Stockholm, Sweden: European Centre for Disease Prevention and Control; 2015.
Calvet Detection and sequencing of Zika virus from amniotic fluid of fetuses with microcephaly in Brazil: a case study. Lancet Infect Dis 2016.
Epub February 17, 2016.To Ask a Question
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